Healthcare Provider Details

I. General information

NPI: 1164730339
Provider Name (Legal Business Name): STEPHANIE NICOLE KAMINSKA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE NICOLE KOTT PA

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 TRANSIT RD SUITE 105
EAST AMHERST NY
14051-2610
US

IV. Provider business mailing address

8750 TRANSIT RD SUITE 105
EAST AMHERST NY
14051-2610
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-1470
  • Fax: 888-886-2563
Mailing address:
  • Phone: 716-636-1470
  • Fax: 888-886-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number014158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: